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The role of IQOS risk perceptions on cigarette smoking behaviours: results from a prospective pilot study
  1. Teresa DeAtley,
  2. Matthew D Stone,
  3. Andrew A Strasser,
  4. Janet Audrain-McGovern
  1. Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Teresa DeAtley, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; teresa.deatley{at}


Background IQOS is a heated tobacco product marketed as an alternative to combustible cigarette smoking. Little is known about cigarette smokers’ IQOS health risk perceptions and if these risk perceptions impact IQOS use and cigarette smoking behaviour.

Methods Adult, daily, non-treatment-seeking cigarette smokers (n=27), naïve to IQOS, were recruited from Philadelphia, Pennsylvania, USA. Participants were introduced to IQOS and then completed measures of risk perceptions. Participants were given an IQOS 2.4 holder, charger and HeatSticks, and asked to switch completely from cigarettes to IQOS for 14 days. The effects of risk perceptions on changes in IQOS use, cigarettes per day (CPD), the substitution of IQOS for cigarettes and motivation to quit smoking were evaluated.

Results Over the 14-day switch period, CPD significantly decreased (B=−0.18, 95% CI=−0.26 to –0.09, p<0.0001), IQOS use significantly increased (B=0.02, 95% CI=0.00 to 0.03, p=0.042), as did the percentage IQOS HeatSticks that replaced CPD (B=0.02, 95% CI=0.01 to 0.03, p=0.005). Participants who perceived IQOS as less risky than cigarettes used fewer IQOS HeatSticks per day. A lower percentage of IQOS HeatStick substitution for cigarettes was observed for participants with higher versus lower risk perceptions (B=−0.14, 95% CI=−0.28 to –0.01, p=0.042). Motivation to quit increased from a mean of 5.53 to 6.79 on the contemplation ladder from baseline to day 14 (B=1.26, 95% CI=0.54 to 1.97, p<0.001).

Conclusions Smokers reduced their smoking rate and increased motivation to quit smoking while using IQOS. IQOS risk perceptions did not directly account for reductions in smoking, although they may contribute indirectly through increased IQOS use.

  • Non-cigarette tobacco products
  • Addiction
  • Advertising and Promotion
  • Harm Reduction
  • Nicotine

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  • Contributors JA-M was the principal investigator responsible for the study. JA-M and AAS helped to conceptualise the study. MS conducted the analyses. TD prepared the table and wrote most of the manuscript with the help of MS and JA-M. AAS aided in interpreting the analysis and critically reviewed and revised the manuscript. All authors approved the manuscript.

  • Funding Research reported in this publication was supported in part by the National Cancer Institute (NCI) of the National Institutes of Health (NIH) and the US Food and Drug Administration (FDA) Center for Tobacco Products under Award Number U54CA229973.

  • Disclaimer The content is solely the authors' responsibility and does not necessarily represent the official views of the NIH or the FDA.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.